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Several weeks ago, I saw a patient who noted sudden-onset visual field loss. On physical examination, confrontation testing using a “finger-wiggle” technique suggested a homonymous superior quadrantanopsia, and magnetic resonance imaging subsequently confirmed a left occipital stroke. But how accurate are confrontation maneuvers?
New Zealand researchers assessed the accuracy of confrontation visual field testing in 163 consecutive patients (301 eyes) presenting to a neuro-ophthalmology clinic. Neuro-ophthalmology fellows performed seven confrontation tests, and results were compared with those of computerized automated static perimetry (the reference standard); abnormalities, including anterior lesions (e.g., glaucoma-related) and posterior …